Provider Demographics
NPI:1134383490
Name:DESAI RADIOLOGY PA
Entity type:Organization
Organization Name:DESAI RADIOLOGY PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MEHUL
Authorized Official - Middle Name:B
Authorized Official - Last Name:DESAI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:954-303-3332
Mailing Address - Street 1:7026 NW 68TH DR
Mailing Address - Street 2:
Mailing Address - City:PARKLAND
Mailing Address - State:FL
Mailing Address - Zip Code:33067-4728
Mailing Address - Country:US
Mailing Address - Phone:954-303-3332
Mailing Address - Fax:954-752-8781
Practice Address - Street 1:7026 NW 68TH DR
Practice Address - Street 2:
Practice Address - City:PARKLAND
Practice Address - State:FL
Practice Address - Zip Code:33067-4728
Practice Address - Country:US
Practice Address - Phone:954-303-3332
Practice Address - Fax:954-752-8781
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-16
Last Update Date:2008-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME63393174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty